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Individual
MR. DOMINGO GONZALES JAVIER
Active
Individual
MR. DOMINGO GONZALES JAVIER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
10588
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0127512000
—
WV
01
—
0472131
UMWA FUNDS
—
01
—
062480
BC ANTHEM
VA
01
—
1022384
WORKERS COMP
WV
01
—
103541
BLACK LUNG
—
01
—
4454937
AETNA
—
01
—
7350431
VA MED ASSIS
VA
01
—
851945
MAMSI
—
01
—
V000267
CHAMPUS
—
Enumeration date
09/19/2006
Last updated
07/08/2007
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